Updated: Aug 29
Editor’s Note: Today, Points brings you the second in a series of posts on silencing and substance use by Heather Sophia Lee, PhD, LCSW, an Assistant Professor of Family Medicine and Community Health at Rutgers’ Robert Wood Johnson Medical School. You can read the first installment here.
I chose to focus my time as a guest blogger on Points focusing on the Silences of Our Work because, in the academic spaces in which I exist, I am most frustrated by what goes unsaid. The gold standard of “science” calls for ignoring certain variables, so that other variables may be tightly controlled. Our work is silenced by design.
Trauma figures prominently in the lives of many of our clients and their relationship to substances, but is often silenced in our work. I don’t mean that everyone who struggles with alcohol and other drug use has experienced trauma– but many people I’ve worked with have, yet the existence of trauma is largely unacknowledged in mainstream discourse about substance abuse in the United States. In my qualitative interviews and clinical work with participants of harm reduction programs, trauma frequently plays a role in participants’ narratives about their relationship to alcohol and other drugs. Yet in the discourse about these clients, trauma rarely enters the conversation. The “why behind the what” is absent.
This TED Talk by Liz Mullinar addresses the relationship between childhood trauma and mental health and substance abuse. In it, Mullinar discusses the common complaint among young women she works with who have attempted suicide. The complaint is that afterward, no one ever asked them why they attempted suicide.
Our silence about trauma frustrates me both personally and professionally. As I discussed in my first post about the silencing of the “addict” identity, I have felt its damage personally. Professionally, I’ve witnessed the silencing of trauma as a cultural phenomenon.
Barbara Ehrenreich’s Bright Sided: How Positive Thinking is Undermining America, is one book that captures our culture’s discomfort with discussions of trauma. Ehrenreich discusses how her cancer diagnosis was met with optimistic scripts about how she should view her diagnosis; these positive affirmations actually denied her capacity to feel what she felt. I don’t think Ehrenreich is alone in being met with rote phrases like “stay positive” when faced with suffering. Positive thinking isn’t inherently bad, but when it’s used in a way that silences, it thwarts the human connection critical to healing.
This phenomenon is relevant to our work: there are few social issues which incite as much judgment, stigma, and lack of compassion as the abuse of alcohol and other drugs. Once someone is labeled an “addict”, the right to be heard and self-determined disappears. This silencing is compounded by denying someone struggling with substance use the right to express emotional pain. Many individuals I interviewed for my research on harm reduction programs said their attempts to discuss their underlying issues in self-help settings were met with slogans like “get off the pity pot.”
While I don’t believe that practitioners should assume responsibility for speaking for our clients, our capacity to hold space for clients to speak for themselves is critical. It is crucial in eliminating barriers to human connection. Allowing someone to tell their story fosters compassion; compassion provides space for healing. It shifts the framework from one that judges the client as “bad” to one that acknowledges the client’s resilience in the face of adversity. Dr. Megan McElheran’s TED Talk on Trauma, Resilience, and Change makes the case for the power of healing through relationships — the relationship being the critical ingredient in our capacity to heal.
Again, my personal experiences in this area have mimicked my professional ones.
I’ve experienced personally how difficult it is for others to respond to your suffering in a way that silences – through advice offering, an anxious need to “fix”, or a fear of saying the wrong thing (thus ending the conversation altogether). I have also had the opportunity to observe these processes systematically.
When you work in substance abuse treatment, you’re met with many assumptions about what your work life must be like from those around you. I learned most about our mainstream culture’s discomfort with suffering in my social work training in an inpatient hospice unit, where I regularly confronted death and dying. Practitioners are often met with awkward silences when revealing what we do. There are assumptions about “how hard” it must be. These assumptions fail to see the beauty of resiliency that we are able to witness when we’re not afraid to work through the suffering, rather than side-step it.
In Mark Epstein’s recent book, The Trauma of Everyday Life, he discusses integrating Buddhist philosophy into his work as a psychiatrist. A key tenet of this work is the acceptance that suffering is a basic fact of life. I often wonder if it is our addiction to the denial of this reality – that to live is to suffer – that puts us at greater risk for other addictive behavior.
Whether our work is housed in social service, healthcare, or academia, a set of constraints govern our everyday work. Grant-funded and incentive based programs, as well as the ever-increasing pressure to demonstrate evidence-based outcomes define our work, sometimes hinder our capacity to meet the client/patient where they are. Those of us who resist are at risk of being labeled “inefficient clinicians.” We live in a world that rewards reductionist approaches, not nuanced compassion.
For this reason, I express deep gratitude to the clients who share their stories of resiliency in spite of the attempts to silence them, and the clinicians and practitioners who insist on holding the space for them to do so.